Hospitals & health systems
Benchmark each service line against nearby hospitals and ASCs.
PayerPrice is a healthcare price transparency platform for hospitals and health systems. Check rates against peers and contracts.
Not ready for a call?
A hospital-wide average hides which departments are underpaid.
Each service line has its own codes, rate forms and payers. Compare them one at a time, against the hospitals and surgery centers that offer the same services.
BCBS of Texas | Hospital outpatient | Sept. 2026 files
One hospital is above market in GI and orthopedics and at 47% of the median for MRI.
- GI · colonoscopy 45380
- 167%
- Orthopedics · knee arthroscopy 29881
- 122%
- Imaging · knee MRI 73721
- 47%
Source: payer in-network files, Sept. 2026. Hospital A's rate as a share of the median across 242 Texas hospital Tax IDs. How we count
Prepare a rate proposal the payer can check.
See hospital price transparency dataCheck published rates against the contracts.
Upload payer contracts, search them by term or ask a question, and pull out DRG, per diem and carve-out terms.
Which published rate is the hospital's?
- ContractsPDFs and fee schedule spreadsheets
- SearchBy term, or ask a question with page citations
- Extracted termsDRG, per diem, stop-loss and carve-out terms
Contracted rates checked against the published files
- BCBS agreement.pdfSearch terms, ask a question
- Fee schedule.xlsxExtracted rates by code
- Amendment 3.pdfCarve-outs and stop-loss
Compare each service line with nearby providers.
Line up the same code and rate form across hospitals, health systems and ASCs, payer by payer.
BCBS of Texas | Facility rates | Sept. 2026 files
The same procedures, hospital and ASC medians
- Knee arthroscopy 29881
- $6,282Texas hospitals$2,701Texas ASCs
- Colonoscopy 45380
- $2,485Texas hospitals$1,171Texas ASCs
Medians across 242 hospital and about 480 ASC Tax IDs, each Tax ID's highest rate. How we count
Value the gaps and take them to the renewal.
Model the 25th, 50th or 75th percentile, then export the workbook, a draft payer letter and the source rows.
What is each target worth?
- RevenueAnnual revenue by code and payer
- Current rateHospital A's knee MRI rate, $753
- TargetThe 25th, 50th or 75th percentile
The annual gap to each target, with the source rows
| Target | Rate · 73721 | Annual gap |
|---|---|---|
| 25th percentile | $1,014 | |
| Median | $1,594 | |
| 75th percentile | $1,882 |
Hospital benchmark
Hospital A vs. median · BCBS TX
Knee arthroscopy medians · 29881
Value of each MRI target · assumed $500K
- Move to the 25th+$173K/yr
- Move to the median+$559K/yr
- Move to the 75th+$750K/yr
Hospital A by service line · BCBS TX
| Service line | Code | Rate | Median |
|---|---|---|---|
| GI | 45380 | $4,157 | $2,485 |
| Orthopedics | 29881 | $7,665 | $6,282 |
| Imaging | 73721 | $753 | $1,594 |
See one service line against its market.
Pick a service line and a payer. We'll show where the hospital's rates sit beside nearby hospitals and ASCs.
Where the numbers come from
Every rate here comes from a file a payer or hospital is required by federal law to publish.
Data from Sept. 2026 payer files · Updated Nov. 2026
Federal price transparency files
Commercial payers' in-network rate files, required since July 2022, and hospital price files.
Kept with its source
Every rate keeps its payer, provider, code and file month, and exports to Excel with its source rows.
Where the data comes from
Commercial in-network rates, refreshed monthly back to August 2023. A published rate is the agreed rate, not what a claim paid. Medicare Advantage, Medicaid, workers' comp and out-of-network rates aren't included.
How we count and limits to know
- How we count. Each Tax ID counts once, at its highest published rate for the code. This is configurable: in the app you can group by NPI, by Tax ID or by both.
- Payers list some providers who rarely bill a code, which can stretch the high end.
- Percent-of-charges, per diem and case rates aren't dollar amounts. Compare them with like terms, or apply them to charges first.
- Stop-loss, outlier and carve-out terms are often missing from the files. A negotiated rate is not the amount a claim paid.
Common questions
Where does PayerPrice get hospital rate data?
From commercial payers' in-network files and the price files hospitals must publish. Data refreshes monthly, about 30 days behind, with history back to August 2023. Some payers publish few hospital rates in some markets. Medicare Advantage, Medicaid, workers' comp and out-of-network rates aren't included.
How do my hospital's commercial rates compare with other hospitals in my market?
Filter by state, county or the hospitals you choose and see where a rate falls in each payer's range, by MS-DRG, revenue code, CPT or HCPCS code. For an outpatient knee MRI (CPT 73721), the BCBS of Texas median dollar rate is $1,594 and the 75th percentile is $1,882 across 242 hospitals.
Can we compare hospital outpatient rates with ambulatory surgery centers?
Yes. Filter the same code to hospitals or ASCs. For knee arthroscopy (CPT 29881), the BCBS of Texas median facility rate is $6,282 across 242 Texas hospitals and $2,701 across 477 Texas ASCs (Sept. 2026 files, each Tax ID's highest rate).
Can we search and extract terms from our own payer contracts?
Yes. Upload contracts and fee schedules, then search them by term or ask a question and get answers that cite the page. PayerPrice extracts pricing terms such as DRG and per diem rates, stop-loss and carve-outs for your team to review, and can use the contracted fee schedule in the rate model.
Are negotiated rates in transparency files the same as what payers actually pay?
No. A negotiated rate is a contract term. Stop-loss, outlier, carve-out and lesser-of-charges terms can change the payment and are often missing from the files. Claims repricing compares each claim's allowed amount with the matched rate, and needs claim files and a BAA (business associate agreement).
Can we benchmark professional rates for the physicians our hospital employs?
Yes. Professional rates are published separately from facility rates, under the physician group's Tax ID and NPI. Compare them at the facility place of service, and use the -26 professional component for imaging and other split-billed codes.
Prepare for the next payer renewal.
Check each service line against the hospital's own contracts and nearby peers.